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NPI Code Detail

MEDICARE: STEPHEN BLAKELY EZZELL CRNA

MEDICARE: STEPHEN BLAKELY EZZELL CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist1083935AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1051522300OTHERALBLUE CROSS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164474623
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN BLAKELY EZZELL CRNA
Provider Business Mailing Address
First Line : PO BOX 6907
Second Line :
City : DOTHAN
State : AL
Zip : 36302
Country : US
Telephone Number : 334-793-5000
Fax Number : 334-615-8419
Provider Business Practice Location Address
First Line : 4370 W MAIN ST
Second Line :
City : DOTHAN
State : AL
Zip : 36305-1056
Country : US
Telephone Number : 334-793-5000
Fax Number : 334-615-8419
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 06/09/2026

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